Research Article

National blindness control programme in district

Gandhinagar, Gujarat
Shilpa Bhatt1*, Pina Soni2, Alok Chaurasia3
1
Assistant Professor, Department of Ophthalmology
Ophthalmology, GMERS, Gandhinagar, Gujrat, INDIA.
2
Assistant Professor, Department of Ophthalmology, GMERS, GMERS, Sola, Ahmadabad, Gujrat, INDIA.
3
Shyam Institute, Bhopal, Madhya Pradesh, INDIA.
Email: dbcsgandhinagar@gmail.com

Abstract This paper presents a comprehensive picture of the activities carried out by the eye care unit of district Gandhinagar,
Gujarat to successfully implement the National Programme for Control of Blindness in the district. The paper reveals that
the proactive approach adopted by the eye care unit of the district has been effective in realizing the goals and objectives
of the National Programme for Control of Blindness in the district. District Gandhinagar has been able to achieve the goal
of reduction in the prevalence of blindness as laid down in the National Programme.
Keywords: blindness control programme
programme, Gujarat.
*
Address for Correspondence:
Dr. Shilpa Bhatt, Assistant Professor, Department of Ophthalmology, GMERS, Gandhinagar, Gujrat, INDIA.
Email: dbcsgandhinagar@gmail.com
/04/2015
Received Date: 08/04/2015 Revised Date: 22/04/2015 Accepted Date: 25/04/2015

Survey on Avoidable Blindness conducted under NPCB

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DOI: 26 April 2015
INTRODUCTION
India was the first country in world to launch the National
Programme for the Control of Blindness (NPCB) in the
year 1976. The goal of the programme was to reduce the
prevalence of blindness from 1.4 per cent to 0.3 per cent
(Government of India,
dia, 1976). Blindness is defined by the
NPCB as:
Simple Definition: Inability of a person to count fingers
from a distance of 6 meters or 20 feet.
Technical Definition: Vision 6/60 or less with the best
possible spectacle correction OR Diminution of field
vision to 20 degrees or less in better eye.
A survey carried out during 2001-02 02 revealed that the
prevalence of blindness had decreased to 1.1 per cent
while another survey carried out in 2006-07 07 revealed that
the prevalence decreased further to 1 per cent (Rapid
during 2006-07).
07). It is also estimated that the national
prevalence of childhood blindness/low vision is around
0.80 per 1000 child population. Main causes of blindness
in India are:
• Cataract,
• Refractive
active Error,
• Corneal Blindness And
• Glaucoma.
Other causes of blindness include surgical complications,
posterior capsular opacification, posterior segment
disorder, etc.
NPCB addresses these causes through
1. Reduction in the backlog of blindness through
identification and treatment of blind;
2. Developing eye care facilities in every district of
the county;
3. Human resources development for providing eye
care services;
4. Improving the quality of eye care services; and
5. Involvement of voluntary organizations in the
delivery of eye care services.
With the launch of the National Rural Health Mission in
the year 2005 (Government of India, 2005), NPCB has
now been integrated in the framework of the
implementation of thee Mission. India is also the signatory
of the global initiative for the elimination of avoidable
blindness “Vision 2020: The Right to Sight” launched by

How to site this article: Shilpa Bhatt, Pina Soni, Alok Chaurasia. National blindness control programme in district Gandhinagar, Gujarat.
Gujarat
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International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 14, Issue 3, 2015 pp 716-721
the World Health Organization in 1999 in collaboration
with a number of international non-governmental
organizations. The objective of this initiative is to
facilitate reduction of blindness worldwide by bringing
together the resources needed to do so (WHO
Declaration, 1999). NCPB translates this global initiative
into practical action at the community level in India
through developing appropriate national plan to eliminate
avoidable blindness and monitoring the implementation
of the national plan right up to the district level. An
important component of NPCB has been developing and
strengthening eye care facilities in every district of the
country through creating necessary infrastructure and
facilities and providing training to the staff. Core
functions of the district level eye care facility include
1. Cataract operation;
2. Screening of rural population for visual
impairments through the organization of village
based population surveys;
3. School based screening activities directed
towards the identification and redress of visual
impairments in school going children; and
4. Outpatient services in the district hospital and
sub-district and other hospitals within the district.
Over the years, the district eye care facilities have
evolved as the mainstay of the efforts under NPCB to
achieve its goals and objectives as well as the goals laid
down in the global initiative “Vision 2020: The Right to
Sight”.
OBJECTIVE
This paper presents the performance of NPCB in district
Gandhinagar, in the State of Gujarat, India. Gujarat is a
State in the western part of India with a population of
more than 60 million at the 2011 population census
(Government of India, 2011). It is one of the better
developed States of the country with third highest per
capital income at fixed process among the major States of
India – States with a population of at least 20 million at
the 2011 population census. The prevalence of blindness
in Gujarat is reported to be 0.95% per cent according to a
survey carried out in the year 2006 (Rapid Blindness
assessment survey carried out in four Districts -
Banaskantha, Jamnagar, and Kheda and Valsad). District
Gandhinagar had a population of 13,87,478 in the 2011
population census of which 43.16 percent live in urban
regions of district and 56.84 percent in the rural areas.
The State capital of Gandhinagar is located in the district.
The paper is organized as follows. The next section of the
paper summarises the findings based on the annual survey
of rural population that has been carried out in the district
Copyright © 2015, Statperson Publications, International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 14, Issue 3
during the five-year period under reference. This survey
provides the information about the sex ratio of the blind
persons identified during the survey and eye diseases
prevalent in the population surveyed. The third section of
the paper summarises the findings of the school-based
screening programme in the district. This screening
programme provides, among others, the proportion of
students having squint, cataract and refractive error. The
school-based screening programme for blindness control
is one of the key components of NPCB. The fourth
section of the paper presents the progress of NCPB in the
district in terms of the services provided in the context of
blindness control. An important component of services
delivery under the NCPB is cataract operations. The fifth
and the last section of the paper summarises the progress
made under NCPB in district Gandhinagar and puts
forward some recommendations for improving the
efficiency and effectiveness of the implementation of
NCPB at the district level in the effort to achieve national
goals and objectives of blindness control in India.
DATA SOURCE
The paper is based on the reported data related to the
progress of NPCB in the district Gandhinagar maintained
by the district eye care facility located in the Government
Hospital, Gandhinagar for the five-year period 2008-09
through 2012-13. As per the guidelines laid down for the
implementation of NCPB, the district eye care facility has
also been entrusted with the responsibility of collecting
information about the programme performance from
different public and private agencies within the district
including non-government organizations and maintaining
the database of all eye care activities carried out in the
district under the Programme. This database has been
used for analyzing the progress of implementation of
NCPB in district Gandhinagar.
Blindness Survey (Rural)
An important component of the implementation of NCPB
at the district level is active screening of blindness
diseases in the rural population through the organization
of screening camps in the rural areas. An important
advantage of active screening approach is that it
contributes to building awareness and knowledge in the
community about the blindness diseases. The
Gandhinagar district eye care unit has been very proactive
in organizing village based active screening activities to
identify blindness cases and to build community
awareness about blindness diseases as may be seen from
table 1.
2015
 Shilpa Bhatt, Pina Soni, Alok Chaurasia

Table 1: Findings of the village level survey of blindness in district Gandhinagar, Gujarat, India: 2008-09 to 2012-13
Particulars 2008-09 2009-10 2010-11 2011-12 2012-13
Total number of villages 337 339 339 339 339
Villages surveyed 141 156 146 148 150
Proportion of villages surveyed (%) 41.8 46.0 43.1 43.7 44.2
Estimated rural population 1371642 1404166 1404166 1404166 1404166
Population surveyed 559965 489928 524899 354726 427277
Proportion of population surveyed (%) 40.8 34.9 37.4 25.3 30.4
Number of blind persons identified 877 591 340 212 118
Prevalence of blindness (%) 1.57 1.21 0.65 0.60 0.28
Distribution of blind persons
Male 398 280 164 102 59
Female 463 302 161 105 59
Children (Below__ years) 15 8 8 6 0
Blind person sex ratio (F/M) 116 108 98 102 100
Classification of blindness
Cataract 687 431 200 42 12
PC Opacification 32 41 29 11 8
Refractive error 29 23 27 32 26
Corneal opacity 58 39 60 63 33
Injury 10 15 21 21 10
Glaucoma 19 17 27 32 9
Others 40 23 19 11 9

Perhaps the most remarkable observation of table 1 is that Distribution of Blindness

there has been a very significant decrease in the Glaucoma (2008-09)
Injury
prevalence of blindness from around 1.6 per 1000 1%
Corneal 2% Others
opacity
population during 2008-09 to just around 0.28 per 1000 7% 5%
population during 2012-13 which suggests that NCPB Refractive
goal has been achieved in the district. This very steep error PC
reduction in the prevalence of blindness in a short period 3% Opacification
4% Cataract
of only 5 years has been possible because of the very pro-
78%
active approach followed by the Gandhinagar district eye
care unit, especially, in terms of cataract operations as
will be discussed later in the paper. As a result, the Figure 1:
proportion of cataract cases that constituted more than 78
per cent of the total blindness cases during 2008-09
Distribution of Blindness
(Chart 1) reduced to only around 11 per cent during 2012- (2012-13)
13 (Chart 2). This has been possible because of Others Cataract
successfully wiping out the backlog of cataract operations Glaucoma
8% 11%
PC
Opacification
in the district. Cataract accounted for more than 78 per 9%
8%
cent of the total blindness cases identified in the year Injury
2008-09. This proportion has reduced to only around 11 9%

per cent in the year 202-13 primarily because the district Refractive
eye care unit made all possible efforts to operate as much Corneal
error
cataract cases as possible. As a result of the efforts 24%
opacity
organized by the district eye care unit, cataract is no 31%

longer the leading cause of blindness in district Figure 2:

Gandhinagar.
These statistics are important because cataract is a key
cause of avoidable blindness, and timely and efficient
treatment can cause significant improvement in the lives
of such people. In 2012-13, the cataract surgery rate
(CSR) of the state was 1309 per one lakh population
(Socio-economic review 2013-14, Gujarat state), while

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International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 14, Issue 3, 2015 pp 716-721

the CSR achieved in Gandhinagar district was 1741 (No. inequality in the prevalence through a proactive approach
of cataract surgeries-24167 divided by population in lacs- which ensured that more and more females got benefitted
13.87). The leading causes of blindness in the district now from the services made available under the NCPB.
are corneal opacity and refractive error. These two causes Obviously, the Gandhinagar district eye care unit has
of blindness accounted for more than half of the total been successful in achieving the goals and objectives of
blindness cases that were identified in the district during NCPB in district Gandhinagar.
the year 2012-13.
SCHOOL-BASED SCREENING
Blindness Prevalence Rate in Gandhinagar School-based screening for blindness diseases is another
Per 1000 population important activity under NCPB. This activity is directed
1.80
towards school going children. The Gandhinagar district
1.57
1.60 eye care unit has been very proactive in organizing
1.21
1.40 school-based screening activities for the identification of
1.20
1.00
blindness cases in the school going children of the district
0.65
0.80 0.60 as may be seen from table 2. The proactive approach
0.60 0.28 followed by the Gandhinagar district eye care unit has
0.40
0.20
ensured near universal screening of school going children
0.00 in the district. During the year 2012-13, the Gandhinagar
2008-09 2009-10 2010-11 2011-12 2012-13 district eye care unit has been able to screen more than 97
per cent school going children by covering all the schools
Figure 3: in the district. School-based screening of children for
blindness diseases appeared to have also contributed very
Another important observation of table 1 is that there has significantly towards building community awareness
been a significant reduction in the sex ratio of blind about blindness diseases. The school-based screening of
persons. During 2008-09, there were around 116 blind children suggests that there has been some decrease in the
females for every 100 blind males in the district. This prevalence of refractive error in children. During 2008-
ratio now stands 100 blind females for every 100 blind 09, around 4.7 per cent of the children screened were
males. (figure 3) having refractive error – they were either wearing glasses
or they were found to be having refractive error at the
500 463 time of screening. This proportion has come down to
450 398 around 3.9 per cent during the period 2012-13. Similarly,
400
350 302 the prevalence of squint in the children screened appears
280
300 to have come down from around 0.53 per 1000 school
250 Male
200 164161 going children during 2008-09 to around 0.27 per 1000
150 102105 Female school going children in 2012-13 whereas the prevalence
100 59 59
of cataract among school going children appears to have
50
0 decreased from around 0.08 per 1000 school going
2008-09 2009-10 2010-11 2011-12 2012-13
children in 2008-09 to around 0.03 per 1000 school going
children in 2012-13. It is also evident from the table that
Figure 4: Gender-wise distribution of blindness there has been asymmetric variation in the new cases of
refractive error detection rate. This rate was the highest
It appears that, in the past, females living in the rural during the period 2011-12 (more than 2.9 per cent of the
areas of the district were not coming forward at their own total number of children screened) but decreased sharply
for availing blindness control services because of a host to around 1.9 per cent during the period 2012-13.
of social and cultural factors as well as because of poor
awareness in the community about blindness diseases and
their control. However, the proactive approach adopted
by the Gandhinagar district eye care unit has been
successful in eliminating the male-female gap in the
prevalence of blindness in the district. The Gandhinagar
district eye care unit has not only been successful in
reducing the prevalence of blindness in the district but has
also been successful in eliminating the male female

Copyright © 2015, Statperson Publications, International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 14, Issue 3 2015
 Shilpa Bhatt, Pina Soni, Alok Chaurasia

Table 2: Progress of school-based screening of blindness in district The school-based screening of children also shows that
Gandhinagar, Gujarat, India 2008-09 through 2012-13 there has been a very significant decrease in Vitamin ‘A’
2008 2009 2010 2011 2012 deficiency in school going children. In 2008-09, around 6
Particulars
-09 -10 -11 -12 -13 children were found to be having Vitamin ‘A’ deficiency
Total number for every 10 thousand children screened. This proportion
986 1180 1166 1179 1166
of schools
decreased to less than 4 children for every 10 thousand
Schools covered 925 932 1166 1177 1166
Proportion of children screened in 2012-13. A decrease in the
93.8 78.9 100.0 99.8 100.0 prevalence of Vitamin ‘A’ deficiency in the school going
schools covered (%)
Total number children is an indication of an improvement in the living
254039 325786 325786 325786 325786 conditions of the people of the district.
of students
Students
235171 273256 319235 312234 316165
screened SERVICES DELIVERED
Proportion In addition to the above discussed field-based activities
of students 92.6 83.9 98.0 95.8 97.0
organized by the Gandhinagar district eye care unit, an
screened (%)
Students with
idea about the organizational efficiency and
5270 5767 4548 3207 6026 administrative capacity of the unit can also be made in
glasses
New students terms of the delivery of hospital-based services such as
with refractive 5765 5475 7263 9188 6273 cataract operation and outpatient department. There has
error been a substantial increase in the patients attending the
Total student outpatient department for their blindness related diseases
with refractive 11035 11242 11811 12395 12299 and other complications. This shows the increasing
error popularity of Gandhinagar district eye care facility.
Prevalence of Moreover, every year, around 25 thousand cataract
refractive error
operations have been carried out in the district primarily
(%)
Number of
through non-government organizations and private health
students having 124 145 127 81 74 care institutions as a result of the initiative and efforts of
squint the Gandhinagar eye care unit (Table 3). This shows that
Number of the unit has been able to mobilise resources and
students having 19 18 24 4 9 institutions for the cause of the control of blindness in the
cataract district. The Gandhinagar district eye care unit has also
Vitamin ‘A’ been able to organize around 150 camps every year or
142 120 135 109 120
deficiency around 12 camps every month to organize outreach
services to the people. These observations amply reflect
Prevalence of Refractive Error in the administrative capacity and organizational efficiency
Gandhinagar
Per 100 population
of the Gandhinagar district eye care unit in the context of
the implementation of NCPB in the district.
4.70 4.10 4.00 3.90
5.00 3.70
4.00
3.00
2.00
1.00
0.00
2008-09 2009-10 2010-11 2011-12 2012-13

Table 3: Services delivered by the Gandhinagar district eye care unit, Gujarat, India 2008-09 through 2012-13
Particulars 2008-09 2009-10 2010-11 2011-12 2012-13
Cases seen in outpatient department 72433 72361 86342 79782 80556
Spectacles prescribed 39199 39296 45546 44062 40347
Proportion spectacles prescribed (%) 54.1 54.3 52.8 55.2 50.1
Eye collection 211 156 146 124 69
Cataract operations 25215 25230 27509 24333 24167
a. Government institutions 2500 2728 2415 2028 2041
b. Non-government institutions 11848 11323 11912 10416 9734
c. Private institutions 10867 11179 13182 11889 12392
Camps organized 141 156 146 148 150

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International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 14, Issue 3, 2015 pp 716-721

CONCLUSIONS Thus every child with an refractive error received free

The successful implementation of NCPB in district spectacles in Gandhinagar district.
Gandhinagar of Gujarat is very much evident from the
foregoing discussions. The proactive approach followed
by Gandhinagar district eye care unit has largely been Eye donation activity
responsible for this success. The Unit has also been Gujarat district had the 9th highest collection of donated
highly effective in mobilizing non-government eyes as per the report.
organizations and private hospitals in performing cataract
operations so that the backlog of cataract operations could REFERENCES
be wiped out leading to a very significant reduction in the 1. Government of India (1976) National Programme for the
Control of Blindness. New Delhi, Ministry of Health and
prevalence of cataract and hence the prevalence of
Family Welfare.
blindness in the district. Some of the salient features of 2. Government of India (2005) National Rural Health
the proactive approach followed by Gandhinagar district Mission: 2005-2012. New Delhi, Ministry of Health and
eye care can be seen from the Revised NPCB PIP 2011- Family Welfare.
12 as under: In the district wise performance – Up to 3. Government of India (2007) Rapid Assessment of
September – 2010 Avoidable Blindness India. New Delhi, National
Programme for Control of Blindness, Ministry of Health
Cataract Operations
and Family Welfare.
Gandhinagar district had the 4th highest target completion 4. Government of India (2011) Census of India 2011:
(52.18%) behind the districts of Surat (62.40%), Kheda Provisional Population Totals. New Delhi, Registrar
(57.82%) and Surendranagar (53.5%) against the state General and Census Commissioner. Paper 1 of 2011.
average of 45.53% 5. Murthy GVS, Gupta SK, Bachani D, Jose R, John N
School health program (2005) Current estimates of blindness in India. British
Journal of Ophthalmology 89: 257-260.
Gandhinagar district had the second highest number of
6. Sareen IB (2001) National programme for control of
free spectacles provided to school going children (1507 blindness. Health and Population: Perspective and Issues
pair of glasses) behind the district of Amreli (1967 pair of 24(2):99-108.
glasses). The number of children detected with refractive
error was 1507 – which was the 6th highest in the state. Source of Support: None Declared
Conflict of Interest: None Declared

Copyright © 2015, Statperson Publications, International Journal of Recent Trends in Science And Technology, ISSN 2277-2812 E-ISSN 2249-8109, Volume 14, Issue 3 2015